Understanding of Tendon Transfer in Radial Nerve Palsy in Leprosy.

Involvement of Radial Nerve in leprosy is not very common. Only 0.2% of Radial Nerve deformities is observed. There are various procedure to correct the wrist function. We have analyzed various motor units to correct the wrist function as per the patient requirement.

ECRL--a wrist extensor with multiple uses in deformity correction.

Extensor carpi radialis longus muscle has been used in various types of procedures for corrective hand surgery and is a favored muscle for correction of finger clawing due to ulnar nerve palsy in leprosy because its removal leaves an insignificant motor deficit and gives a linear scar at the donor site. It is usually not paralyzed in leprosy. The muscle, being phasic, is easy to re-educate. The excursion of the muscle is similar to lumbrical muscles which it substitutes. Since the muscle is dorsally located, the transfer does not lose tension due to adaptive wrist flexing habit. Its tendon is usually thick enough, can be split into two and used as graft to elongate the muscle-tendon unit or for ligament reconstruction in cases of trapezio-metacarpal joint arthritis.

Abductor pollicis longus deviation grant operation: a new procedure on the thumb in ulnar cum low median palsy for correction of subluxation of carpometacarpal (CMC) joint.

For correction of instability of the carpometacarpal joint (CMC joint) of the thumb in combined paralysis of ulnar and median nerves in leprosy bone fusing procedures have been used, but they are not desirable and can often be avoided. A procedure analogous to the "Extensor pollicis brevis deviation graft operation" for the correction of instability of the metacarpophalangeal joint of the thumb is described here. The new procedure appears to be useful to correct and stabilize the subluxated carpometacarpal joint of the thumb actively during the use of the hand. When thumb web contracture has occurred and the passive range of movement needed for successful opponents replacement of thumb is not available, this new procedure helps to prepare such a severe deformed thumb for correction at earlier time.

Opponensplasty in intrinsic-muscle paralysis of the thumb in leprosy.

For eighty-six cases of leprous paralysis of the intrinsic muscles of the hand, a modified Bunnell opponensplasty (transfer of a finger flexor) was done. Good results were seen in eighteen and fair results in sixty-three. The five poor results occurred because of infection, weakness, or deformity. Adjuvant procedures, as needed, were interphalangeal arthrodeis of the thumb, capsulorrhaphy of the wrist, and additional tendon transfers.